TPLO Exercise Restrictions & General Guidelines

[Pages:2]TPLO Exercise Restrictions & General Guidelines

Postoperative physical therapy and adequate exercise restriction is a very important component of the final outcome of your pet's TPLO. Following the guidelines below will maximize the outcome and limb function as well as avoid complications. If all the recommendations are followed, we expect a very low chance of complications and a return to almost full function (depending on the amount of pre-existing arthritis) with the TPLO procedure. We at AMVS are hoping that by planning ahead it will be easier for you to prepare for your dog's recovery period.

Medications Most dogs will receive medications for pain and to prevent infection. Antibiotics are usually given for 7-14 days after surgery. Pain medications usually are given for approximately 2 weeks, but this may vary depending on your dog's individual needs. Most commonly NSAIDs and Tramadol (a synthetic opioid) are used as postoperative pain medications - please check our website at for further important information. In general, no other medications (including aspirin or aspirin like drugs) should be given.

Post Operative Rehabilitation and Physical Therapy Postoperative rehabilitation and physical therapy is very important for a positive outcome. During the first 1-2 weeks, ice packing the incision two to three times a day for 10-20 minutes is ideal. An ideal icing agent is a 2lb. bag of frozen peas. They conform to the leg and are the correct temperature as well as reusable. A towel in between the leg and the ice pack is recommended so that the incision does not get moist. This treatment can be discontinued 3-5 days after surgery.

Until the staples are removed (in general 10-14 days after surgery) the incision site should be monitored for increased redness, swelling, or drainage, and if any symptoms are observed contact us. Do not allow your dog to scratch or lick at the incision site. Scratching or licking at the incision can lead to a serious infection or incisional separation. Therefore, an e-collar should be worn at all times during the first two weeks until the skin staples are removed.

Some animals show swelling/bruising at the hock and around the hock, which is caused by the surgery at the knee. Such swelling/bruising is normal and can be treated with ice-packing during the first 5 days or later on with hot-packing. Hot-packing can be accomplished by placing a wet towel in the microwave, heating it to a comfortable temperature, placing it in a plastic bag and then placing this bag over the swollen area. This treatment helps to absorb some of the wound fluid and can be done as many times per day as possible (10 min per treatment).

Physiotherapy ideally should begin 2-5 days after surgery. Please contact our physical therapy department, Canine Rehabilitation and Conditioning Group, at (303)762-7946 or for further information.

Swimming (Note: this is different from underwater treadmill which can be started at approximately 3 weeks after surgery): Once bone healing is confirmed (at 8 or 12 week recheck), swimming is an excellent form of rehabilitation. If possible, please have your dog swim 2 to 7 times a week. When swimming, do not allow any running into or from the water or any jumping into the water. Swim for 5 minutes initially and increase as tolerated.

Activity Level In general, if at any time during the recovery, you observe a more severe lameness, soreness, limping, pain, holding the leg up, or not using the leg, you should contact us immediately. While a sudden change

ASPEN MEADOW VETERINARY SPECIALISTS, PC | ANIMAL EMERGENCY AND CRITICAL CARE, LLC

104 S. Main Street Longmont, CO 80501 | Phone 303-678-8844 | Fax 303-678-8855 |

in limb use may indicate a severe problem such as infection or implant failure, many times it can be due to soft tissue injury/sprains that do not require further treatment.

0-2 weeks postoperatively: Activity level during the first 1 week should consist of almost NO exercise! Your dog can go for 5 minute slow walks 3-4 times a day to urinate and defecate. No running, jumping, rough-housing or twisting motions. Your dog should be confined to a small area or airline crate to prevent the running, jumping, or twisting motions. If needed, a sling under the belly can be used for added support when walking, especially on slippery surfaces. Once your dog is able to safely walk on surfaces with non-slippery surfaces such as grass, there is no need for the sling. The sling can also be used to take weight of the hind end if your dog is likely to get excited and tries to jump up.

2-8 weeks postoperatively: You can very slowly (and under a controlled, supervised environment) begin to increase the activity level. Some dogs progress rapidly while others are slower to recover. Take your time and do not rush the healing process. Continue walking 5 minutes at a time, 3-4 times a day. Go slowly enough so that the leg is placed on the floor and weight is placed on it. Continue to prevent running, jumping, and playing. You may increase the walking time by 5 minutes every 1-2 weeks. By 8 weeks you may be walking as much as 20-30 minutes up to 4 times daily if your dog tolerates this without limping. You may also increase the amount of physical therapy exercises (as instructed by our physical therapy department during your first session), including sit and stand exercises, walking up and down hills, walking in circles, etc. If you notice that your dog has gotten more lame or painful, rest for a few days and return to the previous level of rehabilitation.

8-16 weeks postoperatively: After bone healing is confirmed (usually at the 8 week recheck but sometimes 12 week recheck), you may slowly increase activity including some controlled off-leash activity, running and jumping over the next month. It is important to do this slowly. Ideally, you start out with longer lead walks, then start some off-leash activity after a longer walk (to exhaust your dog prior to the off-leash activity). The first off-leash period should be as little as 1 minute! Baby-steps are best to avoid complications. Your dog can be back to completely normal activity at 14-18 weeks after surgery. Again, this part of the recovery should not be rushed since the soft tissues (especially the patellar tendon) have to get used to their changed-function slowly. There are no strict numbers on how much activity is adequate for your dog, the most important part is to avoid multiple set-backs (increased limping).

Rechecks In general, your dog will be discharged the day after surgery. We will provide IV-pain medications the night after surgery. Keeping your dog overnight gives us a chance to send you dog home more fully recovered from anesthesia.

2 weeks after surgery: At the 2 week recheck we examine the surgery site and the stitches or staples in the skin are removed.

8 weeks after surgery: At the week recheck we take radiographs (x-rays) of the surgical site to assess how the bone is healing. After this recheck, activity level may be increased ONLY if bone healing is confirmed at this time. Since some dogs' bones heal slower than others, this recheck is extremely important. If healing is delayed, it may require an additional 4 weeks of the same exercise restriction as weeks 4-8 before the bone is healed.

Also, if bone healing is adequate and if your dog has been diagnosed with bilateral CCL-tears, we can do surgery on the second knee at this time. This timing obviously delays the rehabilitation, and the exercise restrictions begin at week #1 again.

6 months and 1 year postoperatively: These rechecks are used to perform a thorough orthopedic exam and possibly radiographs (x-rays) to assess progression of arthritis as well as any problems with the implants. In some cases, removal of the implants may be recommended. However, this is rarely the case. Some animals have subclinical lameness that may be associated with subsequent meniscal tears, reactions to the implants, subclinical infections. It is better to diagnose these problems early and treat them before they cause clinical lameness. In the case that your dog only had an injury to one knee, we will also assess the other leg for possible problems.

If you have any further questions about the recovery please feel free to contact us! Phone 303.678.8844

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